V/Q mismatch is the most common cause of hypoxemia and a component of most causes of respiratory failure.
In a patient with V/Q mismatch, there will most likely be some areas of the lungs which are better perfused that ventilated and some areas which are better ventilated than perfused. While this occurs to some degree in the normal lung, in V/Q mismatch, it is increased significantly to the point of being pathological.
In COPD, bronchospasm, mucus plugs, inflammation and airway obstruction in general worsen ventilation disrupting the balance between ventilation and perfusion.

